Do you need an over-the-counter sleep aid?

For occasional insomnia, these over-the-counter sleep remedies can help you get the rest you need

By Michelle Villett

A sound sleep can help you maintain a good mood, stay alert and improve work performance. But according to Dr. Jonathan Fleming, co-director of the Vancouver Acute Sleep Disorders Program, many of us aren’t getting enough shut-eye to feel rested and restored. He says one-third of North Americans report difficulties with sleep, and 10 percent of those have significant difficulties. As well, women report having more problems than men.

Any disturbance in sleep quality or quantity—whether occasional or chronic—is classified as insomnia. “It’s usually manifested by a long sleep-onset latency [trouble falling asleep] or awakenings during the night,” says Fleming. Besides daytime fatigue and sleepiness, sufferers may become irritable, depressed or anxious, have difficulty focusing or paying attention, and even experience headaches and gastrointestinal upsets.

Sleep requirements vary, but most people need seven or eight hours, says John Dempster, a Toronto-based naturopathic doctor. Stress is the main cause of temporary insomnia, but insomnia can also result from depressive and anxiety disorders, health conditions that cause pain and discomfort, or certain medications. (For these reasons, chronic insomnia is most common in the elderly.)

Sleep deprivation has an immediate negative impact on brain function, alertness and mood. “There’s also a powerful association between insomnia that lasts over a year and mood disorders,” says Fleming. As well, regular sleep deprivation has been linked to weight gain, weaker immunity, and higher risk of Alzheimer’s, fibromyalgia and heart attacks.

Insomnia becomes chronic when sleep complaints persist longer than four weeks—but Fleming recommends seeing your doctor after two weeks, especially if you are also experiencing daytime symptoms. “Most physicians can do a primary sleep performance assessment to determine whether or not a referral to a sleep clinic is appropriate,” he says. But for occasional sleeplessness that doesn’t last more than a few days, consider one of these remedies. Be sure to follow package directions and warnings closely.

Antihistamine-based sleep remedies

How they work: An active ingredient in these remedies is diphenhydramine hydrochloride, an antihistamine with sedative properties. “It directs receptors in the brain to relax,” says Angela MacNeil, pharmacist and owner at Shoppers Drug Mart in Bedford, N.S. “It usually lasts from six to eight hours.”

Need to know: Follow package directions (the typical dose is 50 milligrams [mg], taken 30 to 60 minutes before bedtime). Although diphenhydramine hydrochloride is not addictive, you can become dependent on it and develop a tolerance, requiring higher doses over time. This is why you should not take it for more than one week without checking with your doctor. Side effects may include dry mouth, dry eyes, daytime sleepiness, confusion and weight gain. Do not use these remedies if you are taking another medication that can cause sedation. They are also not recommended for use by the elderly, who can be more sensitive to the drug’s side effects.

Melatonin-based sleep remedies

How they work: “Melatonin is a hormone secreted by the pineal gland [located in the head],” says Dempster. It helps regulate the body’s sleep-wake cycle; normally, melatonin levels rise in the evening to help us fall asleep and then drop off in the morning. There are two types of synthetic formulas used in the remedies listed above: those that release the melatonin all at once (Jamieson and Webber Naturals) and timed-release systems that release it over several hours (Genuine Health and Nature’s Harmony). “There are no studies yet that show whether the timed-release versions help you stay asleep longer or not,” says MacNeil. How long the effect will last is also unknown.

Need to know: Take three to five milligrams 30 minutes to two hours before bedtime. “I usually recommend starting with an immediate-release formula, and then if that doesn’t work, switch to a timed-release product,” says MacNeil. Possible side effects include drowsiness or dizziness, and headaches, but melatonin is not associated with any severe toxicity (check with your physician or pharmacist, though, if you’re taking other medications). However, some studies show that using melatonin may worsen symptoms of depression. MacNeil advises that it should not be used by those with depression or a history of seizures.

Herbal and mineral sleep remedies

How they work: Both New Nordic and CanPrev contain a form of magnesium. Dempster says this mineral is involved in more than 2,000 chemical reactions in the body—many related to sleep and relaxation—yet many of us are deficient due to stress and a poor diet. As well as magnesium oxide, New Nordic Melissa contains a blend of B vitamins, lemon balm and camomile, which has a sedative-like effect. CanPrev contains magnesium bis-glycinate, which is readily absorbed. FemMed Sleep features 5-HTP, an amino acid that helps restore serotonin—a neurotransmitter that regulates sleep. Valerian (in Swiss Natural Sources) is a herbal extract that targets the same receptors in the brain as the prescription drugs benzodiazepines, but without the addictive properties or memory loss.

Need to know: For all products, check with your doctor or pharmacist if you are taking other medications. For the magnesium remedies, take 200 to 600 mg one hour before bedtime. Do not use FemMed in combination with alcohol, medications or health products that have sedative properties. For the Valerian product, take 400 to 900 mg up to two hours before bedtime. It may leave you feeling groggy or with a headache in the morning, and can take two to four weeks to reach its full potency.

When to see your doctor

If over-the-counter remedies don’t help and your insomnia persists, your physician may refer you to a sleep clinic. “Sleep disorders are diagnosed after a full medical and psychiatric evaluation and after scrutinizing a one-week diary of sleep performance,” says Fleming. The preferred treatments for chronic insomnia are behavioural techniques, including relaxation exercises, sleep scheduling and cognitive therapy.

Some patients require prescription medications such as those that act like benzodiazepines (a type of sedative), zopiclone or temazepam. They should be taken at the lowest dose for the shortest period of time. “But patients with more complicated psychiatric conditions may need different drugs for longer periods of time,” explains Fleming.